Classification

Question 1

In ICD-10, schizotypal disorder is classified under

Select one:
1. Disorders of psychological development
2. Schizophrenia and related disorder
3. Disorders of adult personality and behaviour
4. Cluster A personality disorders
5. Persistent delusional disorder

Answer 1

Schizophrenia and related disorder

Schizotypal disorder is classified along with schizophrenia and related disorders in ICD-10 but along with Cluster A personality disorders in DSM-5. Schizotypy shares some of the clinical features of schizophrenia, but not the delusions or hallucinations. It is thought to be related to schizophrenia because schizotypy is more common in the other first-degree relatives of schizophrenic subjects than in the general population and the relatives for schizotypal subjects have an increased risk of schizophrenia.

Question 2

The duration criteria set out in ICD-10 for diagnosing personality disorders is

Select one:
1. 6 months
2. 2 years
3. 3 years
4. None of the above
5. 1 year

Answer 2

There is no duration criterion for diagnosing personality disorders, though the term ‘enduring’ is applied in descriptions.

Question 3

The multi-axial version of ICD consists of how many axes?

Select one:
1. Five
2. Four
3. Three
4. Ten
5. One

Answer 3

Three

The multi-axial version of ICD-10 uses three axes -Axis 1 - the mental disorder (also personality disorder
and mental handicap);
Axis 2 - the degree of disability;
Axis 3 - current psychosocial problems

Question 4

Which one of the following disorders is characterised by normal language development?

Select one:
1. Asperger’s syndrome
2. Rett syndrome
3. High functioning autism
4. Autism
5. Childhood disintegrative disorder

Answer 4

Asperger’s syndrome

Asperger’s syndrome is characterised by severe persistent impairment in social interactions, repetitive
behaviour patterns, and restricted interests. But the IQ and language are often normal. Unlike autism,
patients with Asperger’s disorder show no delays in acquiring language, cognitive development, or age appropriate self-help skills. Both Rett’s syndrome and Heller’s syndrome of Childhood Disintegrative
Disorder are associated with disturbances in language development.

Question 5

Miss X is a 26-year-old woman who has been treated recently for hypomania with a mood stabiliser. She
also has a past history of depression 3 years ago. Which one among the following is her diagnosis
according to ICD10 criteria?

Select one:
1. Recurrent depressive disorder
2. Mixed affective state
3. Rapid cycling disorder
4. Bipolar disorder type 2
5. Bipolar disorder type 1

Answer 5

Bipolar disorder type 2

Bipolar disorder is divided into 2 main broad types;
- type 1 is characterised by full blown mania or mixed
mania and depression
- type 2 is characterised by recurrent depression and hypomania without episodes of full-blown mania or mixed states.
- Mixed states are cases where manic and depressive symptoms occur simultaneously during the same episode.
- In rapid cycling disorder, there will be at least 4 episodes of bipolar disorder occurring within the period of 1 year.

Question 6

Which term refers to ‘discrete episodes of anterograde amnesia that occur in association with alcohol
intoxication’?

Select one:
1. Pathological intoxication
2. Wernicke’s encephalopathy
3. Korsakoff’s syndrome
4. Alcoholic dementia
5. Alcoholic blackouts

Answer 6

Alcoholic blackouts

Alcoholic blackouts: Alcohol-related blackouts are not included in DSM-IV/ ICD10. Blackouts are discrete
episodes of anterograde amnesia that occur in association with alcohol intoxication. During a blackout (at the time of intoxication), remote memory is intact but patients experience specific short-term episodic
memory deficit (they can talk about their childhood etc., but cannot remember what topic the conversation is about or how did they come to where they were) They can even perform complicated tasks but later will not remember these. The memory gap usually lasts for hours, rarely a day or more. Alcohol blocks the consolidation of new memories into old memories the at the hippocampus.

Question 7

A 32-year-old ex-nurse often presents to A and E with a plethora of complaints. She has undergone many
surgeries in the past. During one such admission, when confronted, she admits to injecting faeces into her blood in order to produce septic blood culture for no apparent reason. What is the most likely diagnosis?

Select one:
1. Malingering
2. Dissociative disorder
3. Munchausen syndrome
4. Conversion disorder
5. Somatisation disorder

Answer 7

Munchausen syndrome

Munchausen syndrome is characterised by self-inflicted lesions and feigned illness with the goal of
receiving medical treatment rather than for any other gain.

Question 8

Dream-like (oneiroid) states with visual hallucinations are features of which of the following?

Select one:
1. Residual schizophrenia
2. Paranoid schizophrenia
3. Catatonic schizophrenia
4. Hebephrenic schizophrenia
5. Post schizophrenic depression

Answer 8

Catatonic schizophrenia

Catatonic schizophrenia is an uncommon subtype which is characterised by psychomotor symptoms
ranging from violent excitement through posturing, negativism, waxy flexibility, perseveration to stupor. It is characterised by marked disturbance of motor behaviour and can present in three clinical forms; (1) excited catatonia (2) stuporus catatonia and (3) catatonia alternating between excitement and stupor. Oneiroid states are also reported.

Question 9

Classificatory systems can be used to make a diagnosis based on inclusion and exclusion criteria. Which of
the following properties of classificatory systems aid in the above?

Select one:
1. Operationalised approach
2. Atheoretical approach
3. Multiaxial approach
4. Aetiological approach
5. Descriptive approach

Answer 9

Operationalised approach

From DSM-III onwards, operationalized diagnosis was introduced. This means using intensity, duration of
the symptoms and impairment criteria while making a diagnosis in an algorithmic manner. Using a
diagnostic checklist more or less, some criteria are necessary while some are optional for a diagnosis.
Characteristic symptoms are pertinent to the diagnosis, such as the symptom of depression that is found in many different disorders. Discriminating symptoms, e.g. thought insertion are important for diagnosis since they are not found in other disorders.

A hierarchy of symptoms, arranged in order of importance often accompanies each diagnostic description in operationalised systems. Additionally inclusion and exclusion criteria may be described to establish the diagnosis

Question 10

Which of the following is a neurological cause of catatonia?

Select one:
1. Hypercalcaemia
2. Adverse drug effect of a neuroleptic medication
3. Encephalatis
4. Hepatic encephalopathy
5. Adverse drug effect of phencyclidine

Answer 10

Encephalatis

The most common psychiatric disorders causing catatonia include major depression and schizophrenia.
Catatonia could also appear as an adverse drug effect of a neuroleptic medication or phencyclidine.
Neurological causes of catatonia include parkinsonism, encephalitis and certain brain tumours. The
common medical causes include hypercalcaemia and hepatic encephalopathy.

Question 11

A 23-year-old man is hospitalized for a fever of unknown origin and persistent cough. He also complains of being increasingly forgetful and having difficulties driving through familiar routes. Physical examination reveals several needle marks in his forearms. The most likely diagnosis is

Select one:
1. HIV dementia
2. Prion disease
3. Cocaine induced brain damage
4. Endocarditis
5. Alcoholic dementia

Answer 11

HIV dementia

Needle marks, persistent cough and fever of unknown origin are suggestive of a HIV infection. Cognitive
symptoms suggest HIV dementia.

Question 12

Which of the following features are noted in emotionally unstable personality- borderline type?

Select one:
1. Unstable and capricious mood
2. Liability to outbursts of anger or violence
3. Chronic feelings of emptiness
4. Marked tendency to quarrelsome behaviour
5. Marked tendency to act unexpectedly and without consideration of the consequences

Answer 12

Chronic feelings of emptiness

Emotionally unstable personality disorder (EUPD) is characterised by a marked tendency to act impulsively
without consideration of the consequences, together with affective instability. Two variants of this
personality disorder are specified in ICD10, and both share this general theme of impulsiveness and lack of
self-control. In the impulsive type, the predominant characteristics are emotional instability and lack of
impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to
criticism by others.

In the borderline type, in addition to emotional instability, the patient’s own self-image,
aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic
feelings of emptiness. A liability to become involved in intense and unstable relationships may cause
repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a
series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).

Question 13

The year of publication of ICD 10 is

Select one:
1. 1996
2. 1992
3. 1990
4. 1948
5. 1994

Answer 13

1992

ICD-10 was published in 1992 and DSM-4 in 1994. The earliest edition of ICD was first published by WHO
in 1948. DSM-3 was published by the American Psychiatric Association in 1980. DSM-2 in 1968, DSM-1 in 1952.

Question 14

Which one among the following is NOT a core diagnostic feature of ADHD?

Select one:
1. None of the above
2. Inattention
3. Hyperactivity
4. Impulsivity
5. Language dysfunction

Answer 14

Language dysfunction

The cardinal features of ADHD are excessive and impairing levels of activity, inattention, and
impulsiveness. Hyperactivity-impulsivity symptoms include: fidgeting, moving, getting up and running about, talking excessively; unable to play quietly; continually interrupting. Inattention symptoms include: being easily distracted, poor attention span and not able to sustain attention; poor task completion; inability to organize, and making mistakes with tasks that require attention; the child is forgetful, and often loses items of daily use.

Question 15

Different types of panic disorder include all except

Select one:
1. Nocturnal panic attacks
2. Situationally predisposed attacks
3. Unilateral panic attack
4. Situational panic attacks
5. Out of blue panic attacks

Answer 15

Unilateral panic attack

Panic attacks cannot be unilateral. They are associated with a generalised autonomic activity and not
directly related to cortical seizures that could be unilateral.

Question 16

Mr.X is a 29-year-old gentleman who has a 6 month history of persecutory delusions about being spied on
at home by his neighbours. There is no evidence of functional impairment. There is no history of past
psychiatric illness or substance misuse. His most likely diagnosis is

Select one:
1. Paranoid personality disorder
2. Simple schizophrenia
3. Schizophrenic form disorder
4. Persistent delusional disorder
5. Paranoid schizophrenia

Answer 16

Persistent delusional disorder

Persistent delusional disorder is a category in ICD 10 that includes all disorders in which persistent
delusions are the prominent and most important clinical features and delusions must be present for at least 3 months. It includes delusions of persecution, delusions of grandeur, delusions of jealousy, somatic
delusions or other non- bizarre delusions. There should be a clear absence of significant or persistent
hallucination and absence of organic mental disorders, schizophrenia and mood disorders. Very often, the
individuals carry on near normal and social and occupational life without arousing suspicion regarding the delusional disorder.

Question 17

Following the death of her 85 year old mother, a 49-year-old receptionist has become increasingly
convinced that the prime minister is in love with her and that they have an ongoing affair. She has clear
thoughts and no hallucinations. She is doing well at work and has no issues with her husband. Which of the following is the most likely diagnosis?

Select one:
1. delusional disorder
2. acute reactive psychosis
3. paranoid personality disorder
4. prodromal schizophrenia
5. schizophreniform disorder

Answer 17

Delusional disorder

Delusions without hallucination and thought disorder, along with preserved family and work functioning is
suggestive of a delusional disorder.

Question 18

A 35-year-old man has low mood, anhedonia, loss of hope on the future, loss of appetite and poor sleep.
He has no other symptoms of depression. What is the severity of his depression?

Select one:
1. Mild
2. Dysthymia
3. Severe
4. No depression
5. Moderate

Answer 18

Moderate

For mild depressive episodes, two symptoms from Criterion A i.e. ‘core symptoms’ + at least two from
Criterion B - ‘other symptoms’, totaling at least 4 overall, must be present. For moderate depression, the count required is 2 + 3 / 4 and for severe it becomes 3 + 4 / 5. ‘4 mild -6 moderate -8 severe’ is an easy way to remember these criteria!

Question 19

Which one of the following eponymous persistent delusional disorders are not correctly matched?

Select one:
1. Capgras syndrome - illusion des sosies
2. Othello syndrome - morbid jealousy
3. Fregoli syndrome-delusional dysmorphophobia
4 .Ekbom syndrome - delusion of infestation
5. De-clerambault’s syndrome - erotomania

Answer 19

Fregoli syndrome-delusional dysmorphophobia

The persistent delusional disorders are characterised by a persistent, often life long, non-bizarre delusion or
a set of related delusions arising insidiously in mid-life or later. Transient auditory hallucinations may occur,
but schizophrenic symptoms are incompatible with a pure diagnosis. Affect, thought and behaviour are
globally normal, but patients’ attitudes and actions in response to these delusions are appropriate and may
lead to dangerousness in disorders such as Othello syndrome.

Question 20

A 21-year-old man has been elated for the last 2 weeks with reduced need for sleep. On mental state
examination, he has pressured speech, racing thoughts and grandiose delusions. The diagnosis is

Select one:
1. Acute stress reaction
2. Hypomania with psychosis
3. Mania with psychosis
4. Hypomania without psychosis
5. Mania without psychosis

Answer 20

Mania with psychosis

The symptoms have lasted for more than a week, which is suggestive of mania. In its more severe form,
mania may be associated with psychotic symptoms such as grandiose delusions

Question 21

A 26-year-old woman has fears of being judged negatively by other people. This is suggestive of

Select one:
1. Borderline personality disorder
2. Avoidant personality disorder
3. Anankastic personality disorder
4. Dependent personality disorder
5. Histrionic personality disorder

Answer 21

Avoidant personality disorder

Individuals with avoidant personality disorder harbour fears being judged negatively by other people,
feelings of discomfort in group or social settings and may come across as being socially withdrawn. They
also have low self-esteem and may crave affection despite an overwhelming fear of rejection.

Question 22

A woman with borderline personality disorder is keen to know which of her symptoms will get better in the
natural course of her life even if she does not take treatment. The correct answer will be

Select one:
1. Identity disturbance
2. Feelings of abandonment
3. Impulsivity
4. Intensity of interpersonal relationships
5. Affective instability

Answer 22

Impulsivity

Symptomatic improvement is common even among the most disturbed borderline patients, and the
prognosis for most, but not all, severely ill borderline patients is better than previously recognized. Impulsive symptoms resolved the most quickly, affective symptoms were the most chronic, and cognitive and interpersonal symptoms were intermediate when followed up for six years.

Question 23

The most common co-morbid psychiatric disorder seen in children with ADHD is

Select one:
1. Conduct disorder
2. Oppositional defiant disorder
3. Bipolar disorder
4. Substance abuse
5. Specific learning disorders

Answer 23

Oppositional defiant disorder

Co-morbid psychiatric illness is common in ADHD children and is seen in 50-80% of cases. 50% children
may meet criteria of 2 comorbid conditions. Oppositional Defiant disorder in 35-50%, conduct disorder 25%, anxiety disorder 25% and depressive disorder 15%. Learning disability 15-40%, specific language impairment in 15-75% children.

Question 24

Which of the following personality types is classified as a Cluster A personality disorder?

Select one:
1. Anankastic personality disorder
2. Histrionic personality disorder
3. Avoidant personality disorder
4. Schizotypal personality disorder
5. Antisocial personality disorder

Answer 24

Schizotypal personality disorder

Paranoid, schizoid and schizotypal personality disorders are classified under cluster A.

Question 25

A man who recently witnessed his colleague's death in an unfortunate road traffic accident presents with weakness of both legs. He is not able to balance himself when asked to stand and needs help to support him. On physical examination, no consistent neurological signs are noted. The most likely diagnosis is Select one: 1. Somatoform disorder 2. Somatisation disorder 3. Conversion disorder 4. Malingering 5. PTSD

Answer 25

Conversion disorder This condition is best described as astasia-abasia. It is a conversion disorder.

Question 26

A child is suspected to have Asperger's syndrome. Which of the following is not consistent with the diagnosis of Asperger's syndrome? Select one: 1. Restricted interests 2. Clumsy motor coordination 3. Abnormalities in reciprocal social interaction 4. Stereotyped motor activities 5. Poor speech development till age 3

Answer 26

Poor speech development till age 3 Language development is typically normal in Asperger's syndrome, differentiating this condition from other autistic spectrum disorders. Note that in DSM-V, Asperger's syndrome is no longer considered as a separate diagnostic entity.

Question 27

Which of the following culture-bound syndromes refer to fear of turning into a cannibal? Select one: 1. Windigo 2. Koro 3. Susto 4. Piblokto 5. Latah

Answer 27

Windigo Windigo involves an intense craving for human flesh and the fear that one will turn into a cannibal.

Question 28

A man who has always had an anxious disposition has been feeling increasingly on the edge, has symptoms of breathlessness, chest pain and nausea that are worsening over the last 6 months. What is the most likely diagnosis? Select one: 1. Adjustment disorder 2. Generalised anxiety disorder 3. Mixed anxiety and depressive disorder 4. Agoraphobia with panic disorder 5. Da Costa syndrome

Answer 28

Generalised anxiety disorder Generalised anxiety disorder is characterized by prominent tension, excessive worry with generalised free floating persistent anxiety and feelings of apprehension about everyday events leading to significant stress and functional impairment. Physical symptoms and features of autonomic arousal are usually seen in GAD. The ICD-10 list contains 22 physical symptoms of anxiety while there are only 6 in the DSM-5 list. Common physical symptoms include breathing difficulties, choking sensations, chest pain, nausea/abdominal distress. The symptoms of autonomic arousal include sweating, palpitations, trembling and dry mouth.

Question 29

A 34-year-old woman appears flamboyant and dramatic in her behaviour, drawing excessive attention to herself. Which of the following is very likely? Select one: 1. Perfectionist behaviour 2. Marital problems related to emotional intimacy 3. Rapid mood swings 4. Anxiety in social situations 5. Preoccupation with rejection

Answer 29

Marital problems related to emotional intimacy This is histrionic personality disorder. It is associated with problems related to emotional intimacy.

Question 30

The concept that overwhelming stress could produce mental illness led to the introduction of which of the following terms in the early 20th century? Select one: 1. Somatisation 2. Alexithymia 3. Moral insanity 4. War neurosis 5. Precocious degeneration

Answer 30

War neurosis War neurosis was the forerunner of the present day concept of Post Traumatic Stress Disorder.

Question 31

Which of the following statements is inaccurate about ICD-10 and DSM-5 classificatory systems used in psychiatry? Select one: 1. Both classificatory systems are categorical systems of classification 2. Both ICD-10 and DSM-5 are diagnostic manuals. 3. Both are based on clinical descriptions 4 .Both use a 5-point axial system 5. They cannot provide case formulations or treatment plans

Answer 31

Both use a 5-point axial system ICD does not use 5-point axial system. The multi-axial version of ICD-10 uses three axes. Axis 1 - the mental disorder (also personality disorder and mental handicap) Axis 2 - the degree of disability; and Axis 3 - current psychosocial problems. The DSM-5 is said to be non-axial but includes dimensional assessment of symptom clusters.

Question 32

According to ICD-10, acute polymorphic psychotic disorder is characterised by an acute onset of a clear psychotic state from a non-psychotic state within a period of: Select one: 1. 2 days 2. 1 week 3. 4 weeks 4. 2 weeks 5. 1 day

Answer 32

2 weeks According to ICD-10, acute polymorphic psychotic disorder is characterised by acute onset from a nonpsychotic state to a clearly psychotic state within 2 weeks and polymorphic picture (unstable and markedly variable clinical picture that changes from day to day or even from hour to hour). There are several types of hallucinations and/or delusions changing in both type and intensity from day to day or within the same day. A marked emotional turmoil which ranges from intense feelings of happiness and ecstasy to anxiety and irritability is also frequently present.

Question 33

A 53-year-old lawyer is concerned about a recent change in the nature of his heart rhythm. His GP has referred him to various cardiologists who were all unable to find any abnormalities in ECG, stress test, perfusion scan, echocardiogram and a 24 hour Holter monitoring. But the lawyer feels that something sinister has been missed and continues spending many hours consulting various books, journals and internet resources to understand his problems. He has stopped working as a result. The most likely diagnosis is Select one: 1. Conversion disorder 2. PTSD 3. Hypochondriasis 4. Munchausen disorder 5. Somatisation disorder

Answer 33

Hypochondriasis Hypochondriasis is characterised by an irrational and overvalued idea of harbouring a physical health problem.

Question 34

Which of the following personality disorders is included in DSM but not ICD? Select one: 1. Schizoid 2. Paranoid type 3. Anxious - avoidant 4. Histrionic 5. Narcissitic

Answer 34

Narcissistic According to DSM-V, narcissistic personality disorder is characterised by impaired self functioning (excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal varying between inflated or deflated extremes), impaired self-direction (goal-setting based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations), impaired empathy (poor ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others) and impaired intimacy (superficial relationships that primarily serve self-esteem regulation; mutuality constrained by little genuine interest in others; experiences and predominance of a need for personal gain); and increased grandosity and attention-seeking traits that antagonise others.

Question 35

Which one of the following has the worst prognosis among the subtypes of schizophrenia? Select one: 1. Residual schizophrenia 2. Catatonic schizophrenia 3. Post schizophrenic depression 4. Hebephrenic schizophrenia 5. Paranoid schizophrenia

Answer 35

Hebephrenic schizophrenia The onset of hebephrenic schizophrenia is insidious, usually in the early second decade. The course is often progressively downhill. There is a rapid development of negative symptoms and disorganised behaviour. Severe deterioration without remission occurs over time. A recovery from the first episode rarely occurs in typical cases.

Question 35

A school teacher suspects Asperger's disease in a young boy. Which of the following would support her concerns? Select one: 1. Poor learning of grammar 2. Other teachers report that he has very few friends 3. He wants to be a gardener 4. The mum reports that he did not speak at all before the age of 3 5. No eye contact during the entire interview

Answer 35

No eye contact during the entire interview Lack of eye contact is often seen in autistic spectrum disorders.

Question 36

A man brings his mother to stay with his family permanently, following her retirement. Soon after this, his wife becomes mute and aphonic. Physical examination reveals no neurological explanation. Most likely diagnosis is Select one: 1. Somatisation disorder 2. Conversion disorder 3. Somatoform disorder 4. Malingering 5. Hypochondriasis

Answer 36

Conversion disorder This condition is best described as hysterical or functional aphonia. It is a conversion disorder.

Question 37

What percentage of non-schizophrenic patients with psychosis exhibit first rank symptoms of schizophrenia? Select one: 1. 40 2. 20 3. 5 4. 10 5. 50

Answer 37

10% Kurt Schneider enumerated a number of symptoms which he believed were of first-rank importance in differentiating schizophrenia from related illnesses. According to the International Pilot Study of Schizophrenia, 58% of patients with acute schizophrenia exhibited at least one first rank symptom. However, at least 20% of schizophrenic never exhibit a first rank symptom while almost 10% of non-schizophrenic patients exhibit them.

Question 38

Which of the following statements regarding PTSD is true? Select one: 1. Specific EEG changes occur in chronic PTSD 2. Previous history of neurotic illness precludes the development of PTSD features 3. PTSD is associated with hypersomnia 4. PTSD symptoms usually occur within 6 months of the perceived trauma 5. Autonomic hyperarousal symptoms are usually rare

Answer 38

PTSD symptoms usually occur within 6 months of the perceived trauma PTSD symptoms usually occur within 6 months of the perceived trauma. The essential features are autonomic hyperarousal, re-experiencing of aspects of the stressful event and active avoidance of cues that remind of the trauma. Anhedonia may also be seen; dramatic acute bursts of anxiety may present as exaggerated startle and hyperarousal. Insomnia is common. Predisposing factors include maladaptive personality traits (e.g. anankastic) or previous history of neurotic illnesses.

Question 39

In which of the following personality disorders, the patient shows a preoccupation to avoid criticism and rejection? Select one: 1. Dependent 2. Anxious Avoidant 3. Borderline 4. Passive aggressive 5. Anankastic

Answer 39

Anxious Avoidant Anxious/Avoidant personality disorder is characterized by a constant perception of tension and apprehension; an unreasonable but pervasive feeling of being inadequate and inferior to others; persistent preoccupation with rejection in social situations; reluctance to develop relationships unless certain of being accepted (and not rejected); avoidance of interpersonal contact due of fear of criticism, disapproval, or abandonment.

Question 40

A 55-year-old woman with suspected multiple sclerosis presents with loss of function in one arm. She does not seem concerned by this defect. This is best described as Select one: 1. Echo de la pensee 2. Moria 3. Palimpsest 4. Bouffee delirante 5. La belle indifference

Answer 40

La belle indifference La belle indifference is a surprising lack of concern for, or denial of, apparently severe functional disability. It is often seen in patients with hysteria and medical illness e.g. a cerebrovascular accident. It is a rare and non-specific symptom of no diagnostic value.

Question 41

A lady comes to your outpatient unit with a diagnosis of OCD made by her GP. Which of the following symptoms is most likely in this patient? Select one: 1. Counting 2. Hoarding 3. Checking 4. Rearranging items on the table 5. Cleaning

Answer 41

Checking Checking is one of the most common features of OCD. It is more common than other symptoms listed in this question.

Question 42

What is the 5th character of the diagnostic code in ICD 10 when classifying patients with schizophrenia? Select one: 1. Aetiology 2. Treatment resistance 3. Prognosis 4. Subtype 5. Course

Answer 42

Course ICD-10 as a whole is designed to be a central ("core") classification system for a family of disease- and health-related descriptions. Some members of the family of descriptions are derived by using a fifth character to specify more detail. For example, in the substance use disorders, the third character indicates the substance used, the fourth and fifth characters the psychopathological syndrome, e.g. from acute intoxication and residual states. In dementias, a fifth character may be added to specify dementia with or without additional psychiatric/behavioural symptoms (e.g. hallucinations). In schizophrenia, the fifth character specifies the course.

Question 43

How long does the natural course of an episode of untreated mania last? Select one: 1. 4 months 2. 9 months 3. 6 weeks 4. 2 weeks 5. 4 weeks

Answer 43

4 months Except in the elderly, the natural course of mania lasts for 4 months while depression for 6 months. This becomes longer in the elderly who show shorter periods of interepisodic remissions and more frequent episodes which are considerably longer.

Question 44

Which of the following is the best test to differentiate delirium from dementia? Select one: 1. Altered consciousness 2. Poor recall 3. Neurological localising signs 4. Presence of visual hallucinations 5. Presence of delusions

Answer 44

Altered consciousness Dementia is not usually associated with altered consciousness unless there is a superimposed delirium, or if the patient is in an advanced state of profound dementia.

Question 45

A 13-year-old boy was sent from school by his teacher as he smelt of alcohol. The GP refers the family to child psychiatric services where his dad reports that his son is less interested in exploring new things. He never joins in on a conversation when there are visitors at home; he gets distressed and sweats profusely when attending parties and other occasions. Most likely diagnosis is Select one: 1. Specific phobia 2. Alcohol dependence 3. Agoraphobia 4. Depression 5. Social phobia

Answer 45

Social phobia Social phobia is characterised by "an intense, irrational fear of one or more social or performance situations in which the individual believes that he or she will be scrutinized by others. Exposure to social situations immediately provokes an anxiety response. In adults, the social phobia is recognized as excessive or unreasonable."

Question 46

What is the time duration before which most cases with acute uncomplicated delirium recover? Select one: 1. 4 weeks 2. 6 months 3. 3 days 4. 1 day 5. 1 year

Answer 46

4 weeks Most cases of delirium recover in 4 weeks; in chronic lung disease, SABE (subacute bacterial endocarditis) and carcinoma up to 6 months long delirium may be seen.

Question 47

Fugue state has been recognised as a type of Select one: 1. Situation specific psychogenic amnesia 2. False memory syndrome 3. Global psychogenic amnesia 4. Post traumatic amnesia 5. Transient global amnesia

Answer 47

Global psychogenic amnesia Psychogenic amnesia is usually caused by psychological factors. There are two types - global and situation specific. Fugue state is a type of psychogenic global amnesia in which there is a sudden loss of all autobiographical memories, knowledge of self and personal identity. Usually, there is a period of wandering, and there is an amnesic gap upon recovery. It usually last a matter of hours or days. Memory recovers fully after few hours or days.

Question 48

Which one of the following was a key proponent of the view that psychological diseases are diseases of the brain? Select one: 1. Greisinger 2. Adolf Meyer 3. Emil Kraepelin 4. Karl Jaspers 5. Charcot

Answer 48

Greisinger Greisinger wrote an influential book and proposed the view that psychological diseases are diseases of the brain. As a result, the old humoral theories were sidelined with new ideas about the connection between mental illness and brain function and the pursuit of these links turned successful for neurosyphilis, cretinism and dementia.

Question 49

In PTSD, which of the following is associated with a poor prognosis? Select one: 1. Vivid memory of the trauma 2. Reduced threat intensity of recalled trauma 3. Florid emotional response at the time of trauma 4. Sense of numbing 5. Unemployment at the time of trauma

Answer 49

Sense of numbing Dissociative symptoms such as sense of numbing, detachment or absence of emotional responsiveness, a reduction in awareness of one's surroundings e.g. 'being in a daze', derealisation, depersonalisation, dissociative amnesia (inability to recall an important aspect of the trauma) are associated with poor prognosis.

Question 50

Which of the following is not a common clinical feature of mania? Select one: 1. Reduced need for sleep 2. Irritability 3. Memory impairment 4. Physical over activity 5. Elated, expansive mood that is not characteristic of the individual

Answer 50

Memory impairment The clinical features of mania includes elated, expansive mood that is not characteristic of the individual, irritability, physical over activity/restlessness, pressure of speech, flight of ideas, disturbed sleep or reduced need for sleep, increased libido, inflated self esteem, over spending, over-familiarity and psychotic symptoms. Grandiose delusions are typical, auditory hallucinations and other delusions including first rank symptoms may also be present. It is equally common in men and women. The mean age of onset is in the early 20's. The earlier the onset perhaps, the greater the genetic loading. It is more common in urban areas and equally distributed among the social classes. The lifetime risk of bipolar disorder is about 1%.

Question 51

A 55-year old man has been suffering from short-term memory problems, and other problems related to concentration. Otherwise, his daily activities are not affected. Which of the following is he most likely to develop? Select one: 1. Vascular dementia 2. Lewy body dementia 3. Huntington's chorea 4. Creutzfelt Jacob disease 5. Alzheimer's dementia

Answer 51

Alzheimer's dementia Patients with Mild Cognitive Impairment (MCI), if progressing to further deterioration, are most likely to convert to Alzheimer's-like dementia.

Question 52

Most children with selective mutism also meet diagnostic criteria for which of the following disorders? Select one: 1. Depression 2. Asperger's syndrome 3. Generalised anxiety disorder 4. Autism 5. Social phobia

Answer 52

Social phobia Selective mutism is a disorder characterized by persistent failure to speak in specific settings (school) despite full use of language at home or with family, may be found in younger children with social phobia. Selective mutism appears to be more common in girls than in boys. Approximately 68% of children with selective mutism also meet diagnostic criteria for social phobia.

Question 53

One of your patients has a co-morbid paranoid personality disorder with a persistent delusional disorder. Identify the correct statement regarding persistent delusional disorders. Select one: 1. Depressive episodes invalidate the diagnosis 2. Delusional disorders are associated with blunted affect. 3. The delusions must be present for a period of at least 3 months 4. Passivity phenomenon is an important feature 5. Persistent hallucinations are notable in most but not all patients

Answer 53

The delusions must be present for a period of at least 3 months The persistent delusional disorders are characterized by chronic, often life-long, non-bizarre delusions often arising insidiously in midlife or later. Transient auditory hallucinations may occur but clear and persistent auditory hallucinations (voices), schizophreniform symptoms such as delusions of control and blunting of affect, or the presence of an organic brain disease are all incompatible with this diagnosis. There is no necessity to have an identifiable stressor. Symptoms should have been present for at least 1 month (DSMIV). ICD-10 specifies at least 3 months for a diagnosis of delusional disorder.

Question 54

Which of the following delusions is least likely to be associated with a delusional disorder? Select one: 1. Erotomanic delusions 2. Delusions of jealousy 3. Hypochondriacal delusions 4. Bizarre delusions 5. Persecutory delusions

Answer 54

Bizarre delusions Delusional disorders, unlike schizophrenia, are characterized by non-bizarre delusions. Note that DSM-V has removed this distinction now as 'bizarreness' is difficult to define clinically.

Question 55

A 24-year-old lady suddenly develops bilateral blindness. She has patchy tunnel-like vision on field testing. She appears not to be bothered by the problem. This is described as Select one: 1. La belle indifference 2. Anosognosia 3. Loss of insight 4. Malingering 5. Anton's syndrome

Answer 55

La belle indifference Conversion / hysterical disorder is called dissociative disorder of motor movement and sensations. The degree of disability in this disorder is very variable. La belle indifference is not universal, but common. The patients are distressed or concerned by the disability. Close friends or relatives might have had the actual organic illness whose symptoms are present in conversion disorder patient. A milder and transient variety is seen in adolescent girls.

Question 56

A patient with long-standing anxiety being managed by GP was recently seen by her psychiatrist who made changes in her medications. She presents to the A&E with hallucinations of her joints being moved and nausea with agitation and anxiety. What is the diagnosis? Select one: 1. Antidepressant withdrawal 2. Benzodiazepine intoxication 3. Benzodiazepine withdrawal 4. Alcohol intoxication 5. Acute transient psychosis

Answer 56

Benzodiazepine withdrawal Symptoms of benzodiazepine withdrawal include autonomic hyperactivity, increased tremor, insomnia, nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions,psychomotor agitation and anxiety. Sometimes grand mal seizures can occur. Kinaesthetic hallucinations are characteristically related to benzodiazepine withdrawal and have been reported in some patients.

Question 57

The increase in recall of the perceived threat of a natural disaster over time is associated with Select one: 1. Gender 2. Social support 3. Lack of improvement in PTSD over time 4. Magnitude of traumatic experience 5. Personality

Answer 57

Lack of improvement in PTSD over time Post-traumatic stress disorder (PTSD) diagnosis often depends on a retrospective, self-report of exposure to a life-threatening event. Recalled threat intensity generally increases from the time of trauma. This amplification in recall intensity is associated with lack of PTSD symptom improvement.

Question 58

According to ICD 10 what is the minimum duration required for a diagnosis of hypomania? Select one: 1. 2 weeks 2. 4 days 3. 2 months 4. 4 weeks 5. 1 week

Answer 58

4 days ICD 10 requires a duration of at least 1 week for mania and at least 4 days for hypomania.

Question 59

A 31-year-old woman 6 days postpartum has not been sleeping well. She has been wandering in the middle of the night. She is ignoring her baby, and reports that "My child is a sign of a terrible disaster about to happen to the world". Which of the following is the most likely ICD10 diagnosis? Select one: 1. Post traumatic stress disorder 2. Severe puerperal disorder 3. Major depressive disorder with psychotic features 4. Delirium 5. Postpartum blues

Answer 59

Severe puerperal disorder This scenario is suggestive of puerperal psychosis, which is classified under F53.1(Severe mental and behavioural disorders associated with the puerperium, not elsewhere classified).

Question 60

Which of the following subtypes of schizophrenia is classified in DSM-IV but not ICD10? Select one: 1. Hebephrenic schizophrenia 2. Undifferentiated schizophrenia 3. Disorganized schizophrenia 4. Paranoid schizophrenia 5. Catatonic schizophrenia

Answer 60

Disorganised schizophrenia is a term used in DSM but not ICD. In ICD-10, this subtype is described as hebephrenic schizophrenia. Note that in DSM-V the subtyping of schizophrenia has been dropped completely.

Question 61

Mrs. Q is a 43-year-old woman who has a long standing history of the mood disorder of over 20 years. Over the last year alone she has suffered from 5 mood episodes and is currently on treatment with Semisodium Valproate. Which one among the following is associated with her condition? Select one: 1. Hyperthyroidism 2. Anti-depressant use 3. Alcohol Abuse 4. Menopause 5. Stressful life events

Answer 61

Anti-depressant use Some patients with bipolar mood disorder have more than four episodes per year; they are called rapid cyclers. 70-80% of rapid cyclers are women. Some of the factors associated with the rapid cycling include the use of tricyclic anti-depressant, low thyroxin level, being a female patient, having a bipolar 2 pattern of illness and the presence of neurological disease.

Question 62

The symptoms of adjustment disorder resolve within a period of Select one: 1. 3 months of termination of the stressor 2. 1 week of termination of the stressor 3. 2 weeks of termination of the stressor 4. 6 months of termination of the stressor 5. 1 month of termination of the stressor

Answer 62

6 months of termination of the stressor Adjustment disorder requires a stressor and that the symptoms should resolve within 6 months of termination of the stressor or its consequences.

Question 63

Which of the following is a correct statement regarding anorexia? Select one: 1. Anorexic women are more likely to have a history of childhood sexual abuse compared to depressed women 2. A significant heritability exists for bulimia but not anorexia 3. The concordance rates for monozygotic twins is higher than dizygotic twins 4. Persistent preoccupation with eating is a characteristic feature 5. Social class distribution of prevalence of anorexia is even

Answer 63

The concordance rates for monozygotic twins is higher than dizygotic twins The concordance rates of anorexia nervosa for monozygotic twins 55% and 5% for dizygotic twins. Early studies found a 30% rate of sexual abuse in patients with eating disorders but later studies showed no excess of childhood physical or sexual abuse (compared to psychiatric controls). Family studies have shown that there is an increased incidence of eating disorders in first-degree relatives (7-12 times higher). A significant heritability exists for anorexia nervosa but not for bulimia nervosa. Persistent preoccupation with eating is a characteristic feature of bulimia. The class distribution is even in bulimia, but anorexia is more frequently seen in people of higher social class, at least among those who seek help from professionals.

Question 64

A 21-year-old man moved from London to Dundee, a month ago. He is complaining of uneasiness, difficult to concentrate and a feeling of inability to cope since the move. The diagnosis is Select one: 1. Generalized anxiety disorder 2. Neurasthenia 3. Social phobia 4. Adjustment disorder 5. Acute stress reaction

Answer 64

Adjustment disorder Adjustment disorder is a state of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or to the consequences of a stressful life event. It usually occurs within 1 month of the stressful event, and the duration of symptoms does not usually exceed 6 months.

Question 65

The degree of Learning Disability is said to be profound if IQ is below Select one: 1. 30 2. 20 3. 25 4. 40 5. 35

Answer 65

20 Profound mental retardation (IQ range below 20) constitutes approximately 1 to 2 percent of those with intellectual disability. Most individuals with profound disability have one or more identifiable causes for their condition.

Question 66

Which of the following is true concerning head injury and schizophrenia? Select one: 1. Genetic predisposition to schizophrenia has no influence on vulnerability for psychosis after head injury 2. Head injury increases risk of non-affective psychosis more than affective psychosis 3. Psychosis related to head injury is usually acute in onset 4. Head injury increases likelihood of developing schizophrenia 5. Children are more susceptible to schizophrenia following head injury than adults

Answer 66

Head injury increases risk of non-affective psychosis more than affective psychosis Head injury, especially in teens, increases the risk of nonaffective psychosis including schizophrenia.

Question 67

Which of the following is true concerning cyclothymia? Select one: 1. It is commonly associated with endocrine disturbances 2. The diagnosis can be made if there is a past history of bipolar disorder 3. Mood stabilisers are of no use in management 4. Hypomania is the most common reason for seeking help 5. It often fails to come to medical attention

Answer 67

It often fails to come to medical attention Cyclothymia is a mild form of episodic affective disorder characterized by the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms (not satisfying the criteria for a major depressive episode) for a period of at least 2 years. Cyclothymia often fails to come to medical attention. After the initial 2 years (1 year in children and adolescents) required for a diagnosis of cyclothymic disorder, there may be superimposed manic or mixed episodes (in which case both bipolar I disorder and cyclothymic disorder may be diagnosed) or major depressive episodes (in which case both bipolar II disorder and cyclothymic disorder may be diagnosed). Cyclothymic disorder often begins early in life. Lifetime prevalence rates for this disorder range between 0.4% and 1.0% in the general population, and between 3% and 5% in mood disorder clinics. In community samples, the cyclothymic disorder is equally common in men and women, but women are more prevalent in clinical settings (in a ratio of approximately 3 to 2).

Question 68

A 40-year-old man with poor medication compliance has a long-running history of dysthymia with episodes of hypomania on prescribing antidepressants. Which of the following best describes his diagnosis? Select one: 1. bipolar II disorder 2. double depression 3. cyclothymia 4. bipolar I disorder 5. bipolar III disorder

Answer 68

Bipolar III disorder Bipolar 3 is a variant of bipolar disorder with minimal depression complicated by antidepressant induced hypomania.

Question 69

A 16-year-old boy who has used cannabis for the first time complains that his legs are being pulled and moved. Which of the following is most likely? Select one: 1. Acute cannabis effect 2. Dyskinesia 3. Complex seizure 4. Schizophrenia 5. Delusional disorder

Answer 69

Acute cannabis effect Kinaesthetic hallucinations and passivity can occur under the acute intoxication-related effects of cannabis.

Question 70

A 40-year-old patient with a history of long-standing problems with hearing voices and feeling under threat from the government now presents with waxy flexibility and resistance to all instructions. He repeats whatever is said during the interview in a stilted voice but does not speak spontaneously. The most likely diagnosis is which of the following? Select one: 1. malingering 2. drug-induced psychosis 3. hebephrenic schizophrenia 4. catatonic schizophrenia 5. elective mutism

Answer 70

catatonic schizophrenia Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition. The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations (ICD-10)

Question 71

Who first described Bulimia Nervosa? Select one: 1. Crow 2. Liddle 3. Russell 4. Greisinger 5. Klerrmann and Weissmann

Answer 71

Russell Russell first described Bulimia in 1979. Greisinger described unitary psychosis in 1868. Crow published his two syndrome (Type 1 and 2) hypothesis of schizophrenia in 1980. Liddle described the three-syndrome model of schizophrenia in 1987. Klerrmann and Weissmann introduced interpersonal psychotherapy.

Question 72

A 22-year-old woman presents with intense emotions, repeated wrist-cutting, affective instability, and unstable relationships. Select the most likely risk factor for her diagnosis. Select one: 1. Alcohol abuse 2. Sexual abuse 3. Bullying at school 4. Drug abuse 5. Death of mother before the age of 12

Answer 72

Sexual abuse This is a case of borderline personality disorder. Many patients with borderline traits have suffered physical and sexual abuse and exposure to chaotic parenting during childhood.

Question 73

Which one of the following can be a discriminating symptom while making a clinical diagnosis? Select one: 1. Memory problems 2. Poor concentration 3. Thought withdrawal 4. Panic attacks 5. Anhedonia

Answer 73

Thought withdrawal Thought withdrawal is a first rank symptom for a diagnosis of schizophrenia.This is considered to be a discriminating symptom while making a clinical diagnosis.

Question 74

Which of the following subtype of schizophrenia is diagnosed when a psychotic episode is followed by minimal or reduced symptoms present for at least a year? Select one: 1. Paranoid schizophrenia 2. Residual schizophrenia 3. Post schizophrenic depression 4. Catatonic schizophrenia 5. Hebephrenic schizophrenia

Answer 74

Residual schizophrenia According to the ICD 10 diagnosis residual schizophrenia is characterised by the following features in additional to the general guidelines of schizophrenia which includes prominent negative schizophrenic symptoms, evidence in the past of at least one clear-cut psychotic episode meeting the diagnostic criteria for schizophrenia, a period of at least one year during which the intensity and frequency of florid symptoms such as delusions and hallucinations have been minimal or substantially reduced and absence of organic brain disease or disorder.

Question 75

Which one of the following is not known to be associated with an occurrence of psychotic features during the episode? Select one: 1. Bipolar Affective Disorder - current episode mania 2. Psychotic depression 3. Acute and transient polymorphic psychotic disorder 4. Hypomanic episode 5. Schizo Affective disorder

Answer 75

Hypomanic episode Psychotic features are not seen during a hypomanic episode. The clinical features of hypomania include elated mood, increased energy levels, excitability, lack of sleep, over-optimistic ideation and expansive mood.

Question 76

A patient with schizophrenia experienced his most recent relapse 8 months ago. He currently has low mood, anhedonia, flat affect, apathy and suspiciousness over religious people. For the last 2 weeks he has not eaten well, currently avoids eye contact and appears tearful. Which of the following diagnosis is appropriate? Select one: 1. Simple schizophrenia 2. Residual schizophrenia 3. Mixed bipolar episode 4. Post schizophrenic depression 5. Paranoid schizophrenia

Answer 76

Post schizophrenic depression To diagnose post-schizophrenic depression (ICD10), some schizophrenic symptoms (mostly negative) must be present though not dominating the picture. The most recent episode of relapse must not be more than 12 months ago. If no current schizophrenic symptoms at all the depression can be diagnosed. If florid schizophrenia symptoms with minor affective disturbances noted, then relapse must be suspected.

Question 77

Which one of the following is not a feature of Wernicke's encephalopathy? Select one: 1. Confusion 2. Memory disturbances 3. Ataxia 4. Nystagmus 5. Hyperthermia

Answer 77

Hypethermia The classical triad of ophthalmoplegia, ataxia and confusion is rarely present in Wernicke's encephalopathy. A presumptive diagnosis of Wernicke's encephalopathy should, therefore, be made in any patient undergoing detoxification who experiences any of the following signs; ataxia, hypothermia and hypotension, confusion, ophthalmoplegia/ nystagmus, memory disturbances and coma/unconsciousness.

Question 78

The onset of autistic disorder is usually before the age of Select one: 1. Three 2. Eight 3. Four 4. Five 5. Two

Answer 78

Three By definition, the onset of autistic disorder is before the age of 3 years, although in some cases, it is not recognized until a child is much older. Autistic disorder is four to five times more frequent in boys than in girls.

Question 79

Which of the following traits in a woman with borderline personality disorder would resolve at least partially over 2 years time with or without treatment? Select one: 1. Affective instability 2. Anger control 3. Emptiness 4. Self-harm 5. Unstable relationships

Answer 79

Self-harm Collaborative Longitudinal Personality Disorders Study (CLPS) by Gundersen et al. reported that self-harm improves longitudinally over a period of more than 2 years in those with borderline personality disorder.

Question 80

Which of the following is true regarding persistent delusional disorder according to ICD 10 diagnostic criteria? Select one: 1. No hallucinations must be present 2. Only single theme of delusion must be present. 3. More than 3 months duration of delusions 4. Delusions incongruent to mood 5. Preceding stressor should be identifiable

Answer 80

More than 3 months duration of delusions The persistence in persistent delusional disorder is defined as a minimum period of 3 months.

Question 81

The term schizophrenia was coined by Select one: 1. Kahlbaum 2. Freud 3. Kraeplin 4. Jung 5. Bleuler

Answer 81

Bleuler Bleuler coined the term schizophrenia in 1911.

Question 82

A 40 year old lady has had an episode of depression 4 years ago. For last 4 weeks she is low in mood, socially isolating herself and fears going out of home; she feels she will get a panic attack if she goes out. She is quiet tearful and has lost much sleep over her symptoms for last 4 weeks. The most appropriate working diagnosis is depressive relapse; other differential diagnoses are excluded in the above scenario before arriving at the correct diagnosis. This is guided by which of the following principles of classification? Select one: 1. Atheoretical principle 2. Hierarchical principle 3. Descriptive principle 4. Multiaxial principle 5. Operationalised principle

Answer 82

Hierarchical model Hierarchical approach means that certain disorders take precedence over others while making a diagnosis. This follows Jasperian hierarchy starting from organic disorders through to substance use, psychoses, affective disorders, neuroses and personality issues. If a disorder on the top of the hierarchy can explain presenting symptoms, then a diagnosis from the next rung of the hierarchy should not be entertained even if some of the symptoms are consistent with such a diagnosis.

Question 83

Which one of the following symptoms is most frequently noted in schizophrenic patients? Select one: 1. Auditory hallucinations 2. Ideas of reference 3. Suspiciousness 4. Flatness of affect 5. Lack of insight

Answer 83

Lack of insight The International Pilot Study of Schizophrenia survey determined the commonest symptoms exhibited by 306 schizophrenic patients in 9 countries as follows: Lack of insight = 97%; Auditory hallucinations - 74%; Ideas of reference - 70% .

Question 84

Which of the following is a characteristic feature of narcolepsy? Select one: 1. Catalepsy 2. Sleep walking 3. Sleep paralysis 4. Apnea 5. Hypnopompic hallucinations

Answer 84

Sleep paralysis The cardinal symptoms of narcolepsy include excessive daytime drowsiness with sudden onset of REM sleep, often accompanied by cataplexy (sudden loss of muscle tone, provoked by strong emotion). Sleep paralysis and hypnagogic hallucinations may also occur albeit less commonly.

Question 85

In post schizophrenic depression the most recent episode of relapse should be within the last Select one: 1. 12 months 2. 3 months 3. 24 months 4. 6 months 5. 9 months

Answer 85

12 months Some schizophrenic patients develop depressive features within 12 months of an acute episode of schizophrenia. To make a diagnosis of post-schizophrenia depression, the most recent episode of relapse must not have been more than 12 months ago. If no current schizophrenic symptoms at all then the depression can be diagnosed. If florid schizophrenia symptoms with minor affective disturbances are noted, then the possibility of relapse must be suspected.

Question 86

A 30-year-old man is involved in a motorcycle accident, in which his girlfriend (passenger) dies. He presents with paralysis of his left arm, stating he cannot ride a motorcycle again. The doctors find no organic cause. What is the most appropriate diagnosis? Select one: 1. Motor dissociative disorder 2. Acute stress reaction 3. Adjustment disorder 4. Hypochondriasis 5. Neurasthenia

Answer 86

Motor dissociative disorder Dissociative disorders are presumed to be "psychogenic" in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. The onset and termination of dissociative states are often reported as being sudden, and the symptoms usually develop in close relationship to psychological stress. The commonest varieties are loss of ability to move the whole of part of a limb or limbs. Paralysis may be partial, with movements being weak or slow, or complete. Various forms and variable degrees of incoordination (ataxia) may be evident, particularly in the legs, resulting in bizarre gait or inability to stand unaided (astasia-abasia).

Question 87

For four weeks after an automobile accident where her husband died in front of her, a schoolteacher suffer from insomnia, poor concentration and tearfulness. She has nightmares and emotional outbursts when awake. Which of the following is the most likely diagnosis? Select one: 1. post-traumatic stress disorder 2. acute stress disorder 3. dysthymia 4. adjustment disorder 5. depressive episode

Answer 87

acute stress disorder Acute stress reaction: starts usually in an hour; resolution starts within 8 hours if the stress is 'hit and run' type or 48 hours if it is prolonged. The presence of physical exhaustion, organic factors or disease states increases the risk. The stressor is usually one that poses a serious threat to security, integrity and social position. The patient may initially be dazed with narrowed attention; disorientation is not uncommon as a result. Sometimes agitation and overactivity are seen. Partial or complete amnesia for the acute stress reaction is not unheard of. Dissociative symptoms seem to predominate in some.

Question 88

Diagnostic features of neurasthenia include all of the following EXCEPT Select one: 1. Duration >6 months 2. Easy fatiguability after minimal effort 3. Fatigue alleviated by prolonged rest 4. Muscular aches and pains 5. Poor (unrefreshing) sleep

Answer 88

Fatigue alleviated by prolonged rest CFS criteria US-CDCP (1994) suggests that to diagnose CFS (or neurasthenia in ICD10), patients must have persistent or relapsing unexplained chronic fatigue. The fatigue must last for at least 6 months and should not appear to be alleviated by rest.

Question 89

The term that refers to the neglect of all leisure and other alternate forms of pleasure apart from alcohol is Select one: 1. Dependence 2. Tolerance 3. Narrowing of repertoire 4. Reinstatement 5. Salience

Answer 89

Salience Salience refers to the neglect of all leisure and other alternate form of pleasures apart from alcohol. One's life revolves around getting alcohol, storing it, saving money to buy it, making opportunities to drink, etc. Narrowing of repertoire: A social drinker may drink in various situations at various places and may have various drinks of his choice. A dependent drinker will settle into a fixed setting, sticking to one beverage. This may help him maintain a steady level of alcohol in the blood without much fluctuation. Note that some widening of repertoire is inevitable in the career of an alcohol drinker - moving from weekends only to all days of the week, etc.

Question 90

Identify the feature seen only in hysterical but not organic amnesia. Select one: 1. Intact procedural memory 2. All of the above 3. Intact semantic memory 4. Loss of personal identity 5. Impaired episodic memory

Answer 90

Loss of personal identity Loss of personal identity is a unique feature seen in hysterical amnesia. Patients are unable to give their name, address or any personal information. This amnesia essentially cuts them from the previous life. In most cases, he amnesia is transient and the fugue state clears over a few days. If not, the patient usually adopts a new name and identity and begins a new life. As in organic amnesia, those with fugue normally retain their procedural and semantic memories. The patient may have episodic memory loss which is usually only retrograde memory loss, and no anterograde memory impairment is reported.

Question 91

A patient suffers from florid racing of thoughts, decreased sleep, high energy levels and believes aliens are putting thoughts into his brain. He also believes his nail bed is made soft by 'Bull-bull bird'. His history suggests that he always had affective and psychotic disturbances occurring simultaneously. Which of the following chapters will his diagnosis fall under in ICD? Select one: 1. F00 organic 2. F20 schizophrenia 3. F30 mood disorders 4. Not coded 5. F40 neurosis

Answer 91

F20 schizophrenia Schizoaffective disorder is placed with F20 not 30. Both schizophrenic and mood symptoms are seen simultaneously.

Question 92

Choose one best option regarding the distribution of schizophrenia Select one: 1. The incidence of schizophrenia is higher in developing countries 2. Schizophrenia is more common among women than men 3. Fathers of patients with schizophrenia belong to a higher social class than the patients 4. 2% of population has schizophrenia at any given time 5. The prevalence of schizophrenia is higher in developing countries

Answer 92

Fathers of patients with schizophrenia belong to a higher social class than the patients Social drift is associated with a diagnosis of schizophrenia.

Question 93

Characteristic features of delirium tremens include all except Select one: 1. Diarrhoea 2. Fluctuant blood pressure and pulse 3. Hallucinations 4. Clouded consciousness 5. Agitation

Answer 93

Diarrhoea Features of alcohol withdrawal: Usually starts within 12 hours of the last drink. Tremor, diaphoresis, sleeplessness, GI distress and anxiety are prominent. Increased urge and craving for alcohol may be seen. The severity of symptoms depends on the degree of pre-existent drinking. If unattended, symptoms may peak in 48 hours. In these cases, seizures may occur. These are grand-mal seizures especially common in those who had previous seizures (epilepsy or withdrawal seizures), head injury and electrolyte imbalance such as hyponatraemia or hypokalaemia. In around 5% patients, delirium tremens may set in with disturbed autonomic functions (pulse, temperature and blood pressure changes on either direction), clouded consciousness, hallucinations (often Lilliputian) and agitation.

Question 94

Which of the following is true about patients with anorexia nervosa? Select one: 1. The illness has less mortality rate than schizophrenia 2. The most common cause for presentation is comorbid personality disorder 3. The incidence is 35% in the monozygotic twins of affected patients 4. The incidence is 35% in the dizygotic twins of affected patients 5. There is no association between social class and development of anorexia

Answer 94

There is no association between social class and development of anorexia Though earlier studies showed a bias towards higher social class, it is increasingly recognised that this is not accurate

Question 95

Which of the following disorders is believed to represent a point on a continuum of 'unitary psychosis' lying quantitatively between schizophrenic and mood symptoms? Select one: 1. Organic mood disorders 2. Schizoaffective disorder 3. Bipolar affective disorder 4. Psychotic depression 5. Post schizophrenic depression

Answer 95

Schizoaffective disorder In schizoaffective disorder, the symptoms of affective disorder and schizophrenia are present in approximately equal proportion. Both schizophrenic and affective symptoms are present simultaneously present and are equally prominent. The aetiology is assumed to be intermediate to that of schizophrenia and affective disorder. The depressive symptoms are more likely to signal a chronic course compared to manic presentations.

Question 96

Which one of the following statements about Rett syndrome is true? Select one: 1. There is apparent lack of normal development in the first 2 years of life 2. Is associated with microcephaly at birth 3. Occurs mainly in boys 4. Characterised by progressive lack of acquired abilities 5. Is associated with borderline IQ

Answer 96

Characterised by progressive lack of acquired abilities Rett syndrome is a neurodevelopmental disorder that affects girls almost exclusively. It is characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability. From Rett Syndrome Fact Sheet: National Institute of Neurological Disorders.

Question 97

Which of the following traits is seen in paranoid personality disorder? Select one: 1. Fear of abandonment and relying on other people 2. Inability to make decisions 3. Increased sensitivity to criticism and setbacks 4. Does not learn from mistakes 5. Strive for perfection

Answer 97

Increased sensitivity to criticism and setbacks Patients with paranoid traits are often combative and highly suspicious in nature; this may elicit a hostile response in others. They are often critical of others, but have great difficulty in handling even a minor criticism from others.

Question 98

A middle-aged woman went with her husband to see her psychiatrist. She hasn't been sleeping or eating well for the last 4 weeks. She also complains that she feels her bowels are dead and are no longer working. According to ICD-10 the severity of her depression can be classified as Select one: 1. Dysthymia 2. Moderate 3. Mild 4. Severe 5. She has no depression

Answer 98

Severe All depressive episodes with psychotic symptoms are classed as severe according to ICD-10.

Question 99

A 49-year-old man is highly alcohol dependent. Due to various physical problems he was strongly advised to abstain. Unfortunately since last episode of intoxication he has developed recurrent voices that frighten him. In spite of 2 months of abstinence these hallucinations continue, and he now presents with persecutory delusions. Which of the following diagnosis best suits his presentation? Select one: Depressive psychosis Delirium tremens Schizophrenia Alcoholic hallucinosis Delusional disorder

Answer 99

Alcoholic hallucinosis The DSM has a diagnostic criteria for alcohol-induced psychotic disorders (popularly called alcoholic hallucinosis) and further allows the specification of onset (during intoxication or withdrawal). The most common hallucinations are unstructured sounds or voices that may be characteristically malign and threatening. The hallucinations usually last less than a week, when patients believe in the hallucinations though afterwards they may realise the untrue nature.

Question 100

A 27-year-old woman with no previous medical or psychiatric history presents with a two-week history of insomnia, grandiosity, and increased energy. She is in a highly distractible state with a somewhat elated mood. You attempt to do an MMSE, and she scores 23/30. Which is the most likely diagnosis? Select one: 1. Herpes simplex encephalitis 2. Delirium on dementia 3. Bipolar affective disorder 4. Evolving delirium 5. Acute stress reaction

Answer 100

Bipolar affective disorder This patient has features of mania, which has lasted for more than a week. DSM allows a single manic episode to be considered as part of bipolar disorder. People who have mania are very distractible and may not engage well during cognitive testing. Therefore, they may score low on MMSE. In delirium, the duration is much shorter (hours to days), and the patient may present with behavioural disturbances and perceptual abnormalities.

Question 101

Choose the one feature which is not defined under Edwards and Gross criteria (1976) for alcohol dependence syndrome. Select one: 1. repeated withdrawals 2. reinstatement after abstinence 3. narrowed repertoire 4. decreased tolerance 5. subjective awareness of compulsion

Answer 101

Decreased tolerance Edwards and Gross criteria (1976) for alcohol dependence: 1. narrowed repertoire 2. salience of alcohol seeking behaviour 3. increased tolerance 4. repeated withdrawals 5. Drinking to prevent or relieve withdrawals. 6. subjective awareness of compulsion 7. reinstatement after abstinence

Question 102

Which uncommon subtype of schizophrenia is characterised by an insidious development of negative symptoms without evidence of positive symptoms? Select one: 1. Hebephrenic schizophrenia 2. Catatonic schizophrenia 3. Residual Schizophrenia 4. Paranoid schizophrenia 5. Simple schizophrenia

Answer 102

Simple schizophrenia Simple schizophrenia is characterised by an early onset (usually in the second decade), very insidious and progressive course, presence of characteristic negative symptoms like marked social withdrawal, loss of initiative and drive and shallow emotional response. People with this condition drift down the social ladder quickly, living shabbily and wandering aimlessly. Delusions and hallucinations are usually absent; if present, they are short lasting and poorly systematised. The prognosis is usually very poor.

Question 103

A 28-year-old man presents for the seventh time to his GP with abdominal pain. When confronted, he admits to faking symptoms. He says "I know this is wrong, but I don't know why I do this". Which of the following is the most likely diagnosis for this patient? Select one: 1. conversion disorder 2. somatization disorder 3. factitious disorder 4. hypochondriasis 5. malingering

Answer 103

Factitious disorder According to ICD-10 "the patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm in order to produce symptoms or signs. The motivation is obscure and presumably internal with the aim of adopting the sick role. The disorder is often combined with marked disorders of personality and relationships."

Question 104

A mother wants to know the likelihood that her teenage son who has been smoking cannabis for 6 months will develop schizophrenia. The correct answer is Select one: 1 .Nil increase in risk 2. 6 - 7 times 3. 7 - 8 times 4. 5 - 6 times 5. 2 - 3 times

Answer 104

2 - 3 times At present, there is a consensus that cannabis increases the risk of psychosis 2-3 times, especially if the exposure started early in adolescence and persisted to adulthood.

Question 105

According to DSM V, caffeinism is defined as recent consumption of caffeine usually in excess of Select one: 1. 100 mg 2. 50 mg 3. 250 mg 4. 200 mg 5. 150 mg

Answer 105

250 mg According to DSM, caffeinism is defined as "recent consumption of caffeine usually in excess of 250 MG accompanied by five or more of the following; restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia, periods of inexhaustibility, psychomotor agitation", when these symptoms can cause significant distress or impairment in social, occupational or other important areas of functioning and are not due to a general medical condition or better accounted for by another medical disorder (e.g. anxiety disorder).

Question 106

Global assessment of functioning forms which of the following axes in DSM-IV? Select one: 1. One 2. Two 3. Three 4. Five 5. Four

Answer 106

Five The multi-axial System of DSM-IV used 5 axes. Axis I - Clinical Disorders. Axis II - Personality Disorders/ Mental Retardation. Axis III - General Medical Conditions. Axis IV - Psychosocial and Environmental Problems. Axis V - Global Assessment of Functioning. Note that DSM-5 has moved to a nonaxial system for diagnosis, with separate notations for crucial psychosocial factors (formerly Axis IV) and disability or imapirment (formerly Axis V).

Question 107

Which of the following is included as a category of schizophrenia in ICD10? Select one: 1. Schizotypal disorder 2. Paranoid personality disorder 3. Schizoaffective disorder 4. Post-schizophrenic depression 5. Psychotic depression

Answer 107

Post-schizophrenic depression Post-schizophrenic depression (F20.4) is described along with other schizophrenias in ICD10.

Question 108

The term schizoaffective psychosis was coined by Select one: 1. Kretschmer 2. Greisinger 3. Kraeplin 4. Kasanin 5. Kanner

Answer 108

Kasanin The term schizoaffective psychosis was introduced by the Russian-born American psychiatrist Jacob Kasanin in 1933. The earlier concepts of schizoaffective disorder regarded this diagnosis as a good prognosis schizophrenia, with psychoanalytic explanations.

Question 109

A 17-year-old girl has a BMI < 17 and long-standing amenorrhoea. She has a history of purging and laxative use but no body image distortions. The most suitable diagnosis is Select one: 1. Atypical Anorexia 2. Anorexia Nervosa 3. Unspecified eating disorder 4. Atypical bulimia 5. Bulimia

Answer 109

Atypical Anorexia This is an atypical case of anorexia nervosa. The term atypical anorexia nervosa is used for those individuals in whom one or more of the key features of anorexia such as amenorrhoea or significant weight loss is absent but otherwise present a fairly typical clinical feature.

Question 110

The most vocationally disabling personality disorder is Select one: 1. Schizoid 2. Borderline 3. Antisocial 4. Paranoid 5. Obsessive Compulsive

Answer 110

Borderline People with either borderline or schizotypal personality disorder have significantly more occupational impairment than patients with obsessive-compulsive personality disorder.

Question 111

Ganser syndrome is included in ICD under which of the following chapters? Select one: 1. Reaction to stress and adjustment disorder 2. Anxiety disorders 3. Somatoform disorders 4. Other neurotic disorders 5. Other dissociative disorders

Answer 111

Other dissociative disorders Ganser syndrome is included in ICD under other dissociative disorders - F44.80.

Question 112

When comparing DSM IV with ICD-10, which of the following types of schizophrenia is not specified in ICD- 10? Select one: 1. Undifferentiated 2. Paranoid 3. Simple 4. Catatonic 5. Disorganised

Answer 112

Disorganised While simple schizophrenia and hebephrenic schizophrenia are described only in ICD-10, the disorganized subtype is only found in DSM-IV. The description of hebephrenic schizophrenia matches disorganized subtype very closely. Note that the category 'post-schizophrenic depression' is listed along with other subtypes of schizophrenia in ICD-10, not in DSM-IV. Also note that DSM-5 has done away with all subtypes now.

Question 113

A 5-year boy presents to your clinic. He has difficulty relating to others in a social setting and has poor nonverbal social skills. However, he has a normal development of speech and language. What is his most likely diagnosis? Select one: 1. Rett's syndrome 2. Kanner's syndrome 3. Asperger's syndrome 4. Heller's syndrome 5. DiGeorges' syndrome

Answer 113

Asperger's syndrome In Asperger's syndrome, there is usually no language delay or IQ impairment. There is also a notable absence of the early aloofness and stereotypies that are seen in autism. There may be narrow interests and often marked clumsiness.

Question 114

Mr.Z was admitted to a psychiatric ward 7 days ago. On mental state examination, he appeared thought disordered and also had mood-incongruent delusions and hallucinations. His mood symptoms were less marked at this stage. What is the most appropriate diagnosis? Select one: 1. Schizophrenia 2. Secondary Mania 3. Bipolar disorder 4. Unipolar depression 5. Schizoaffective disorder

Answer 114

Schizophrenia In schizophrenia, thought and perceptual disorders are more prominent while mood symptoms are less marked in the initial stages. Delusions and hallucinations are stable. Mood incongruent hallucinations and behaviour are the norm. The patient is incapable of behaving fully consistent with their delusional ideas. While we do not have sufficient information regarding duration of the preceding illness as well as the dysfunction caused, of the options given here, schizophrenia is the most likely possibility.

Question 115

The term simple schizophrenia was added to the categories of existing schizophrenias by Select one: 1. Bleuler 2. Hubbard 3. Hecker 4. Angst 5. Liddle

Answer 115

Bleuler The diagnostic category called simple schizophrenia has a long history; it was one of the traditional schizophrenic subtypes identified by Bleuler and was later accepted by Kraepelin. The term was removed from the official American nosology but has been retained in the ICD system.

Question 116

A 42-year-old man believes that he has contracted a serious infectious condition when he travelled to Burma, where his wife met with an accident. Since then he has had numerous tests including the most sophisticated microbiological investigations but he is not convinced of being healthy. He continues to feel low as a result for the last 1 year. What is the most appropriate diagnosis? Select one: 1. dysthymia 2. somatoform disorder 3. hypochondriasis 4. factitious disorder 5. delusional disorder

Answer 116

Delusional disorder Hypochondriasis is an anxiety state. A patient with hypochondriasis may hold a belief as an overvalued idea but not to a delusional intensity. The patient in question here seems to hold the belief with absolute conviction; it is more likely to be a delusional disorder.

Question 117

Mr.X has been treated recently for hypomania. He also has a previous history of depression. Which one among the following is his correct diagnosis? Select one: 1. Recurrent depressive disorder 2. Bipolar disorder type 1 3. Bipolar disorder type 2 4. Rapid cycling disorder 5. Mixed affective state

Answer 117

Bipolar disorder type 2 Bipolar affective disorder is divided into two main broad types; Type 1 is characterised by full-blown mania or mixed mania and depression, Type 2 is characterised by recurrent depression and hypomania without episodes of either mania or mixed states. Mixed states are cases where manic and depressive symptoms occur simultaneously. Rapid Cycling: When at least four episodes of bipolar disorder occur within a period of one year, the condition is described as 'rapid cycling'.

Question 118

A 34-year-old woman becomes very tearful when her husband has to travel for work to a different place temporarily as she thinks she is unable to function without him. This is a feature of Select one: 1. Histrionic personality disorder 2. Borderline personality disorder 3. Anankastic personality disorder 4. Anxious personality disorder 5. Dependent personality disorder

Answer 118

Dependent personality disorder Features of dependent personality disorder- assumes a position of passivity, allowing others to assume responsibility for most areas of their daily life, lack self-confidence, feel unable to function independently of another person, feels own needs are of secondary importance.

Question 119

What is the minimum duration required to make a diagnosis of alcohol dependence according to ICD-10 criteria? Select one: 1. 2 months 2. 3 months 3. 1 month 4. 12 months 5. 6 month

Answer 119

12 months ICD10 alcohol dependence requires at least 3 features out of following list satisfied in the last 12 months: 1.intense desire to drink alcohol 2. difficulty in controlling the onset, termination and the level of drinking 3. experiencing withdrawal symptoms if alcohol is not taken 4. use of alcohol to relieve from withdrawal symptoms 5. tolerance as evidenced by the need to escalate dose over time to achieve same effect 6. salience - neglecting alternate forms of leisure or pleasure in life 7. A narrowing personal repertoire of alcohol use.

Question 120

Which one of the following is an ICD-10 diagnostic feature of frontotemporal dementia? Select one: 1. Insidious onset and gradual progression 2. 3-6 months history of cognitive decline 3. Memory impairment precede behavioural manifestation 4. Older age of onset 5. Abrupt onset and rapid progression

Answer 120

Insidious onset and gradual progression The ICD-10 diagnostic features of fronto-temporal dementia include a progressive dementia commencing in late middle life, with slowly progressing changes of character and social deterioration, followed by impairment of intellect, memory and language functions. The behavioural manifestations commonly precede memory impairment.

Question 121

The diagnosis of induced delusional disorder is most commonly found in which of the following groups? Select one: 1. Family blood relations 2. Couple relationships 3. Children and adolescence 4. Groups of men rather than women 5. Groups of women rather than men

Answer 121

Couple relationships Induced delusional disorder is more common in a couple but is occasionally seen in groups. This is a rare delusional disorder characterised by sharing of delusions between usually 2 or occasionally more persons who usually have closely knit emotional bonds. Only one person has genuine delusions due to underlying psychiatric disorder, most often schizophrenia or delusional disorder. On separation, the dependent individual may give up his or her delusions and the patient with the genuine delusions should be treated appropriately.

Question 122

You are seeing an elderly man with a history of low mood. He says he was feeling well until 18 months ago but progressively became low in his mood since then. He also complains of becoming more forgetful over the last year. However, he has no problem sleeping and appetite remains reasonably stable. Few months ago, he woke up suddenly with a limp and has been suffering from it since then. What is the most likely diagnosis? Select one: 1. Alzheimer's disease 2. Multiple sclerosis 3. Cerebro-vascular accident 4. Lewy body dementia 5. Depression

Answer 122

Cerebro-vascular accident Vascular insufficiency in the elderly is often associated with both cognitive impairment and depression that can be difficult to treat.

Question 123

Which one of the following is not categorised as a pervasive developmental disorder? Select one: 1. ADHD 2. Asperger's syndrome 3. Autism 4 .Childhood disintegrative disorder 5. Rett syndrome

Answer 123

ADHD According to DSM-IV PDDs include autism, Asperger's syndrome, Rett syndrome, Childhood disintegrative disorder and PDD-Not Otherwise Specified. Note that in DSM-V, Asperger's syndrome is described as an autism spectrum disorder.

Question 124

Mr.X is a 27-year-old gentleman with a long standing diagnosis of schizophrenic illness. He has both positive and negative symptoms of schizophrenia. Which among the following is classified as a negative symptom of schizophrenia? Select one: 1 .Hallucinations 2. Bizarre behaviour 3. Affective flattening 4. Delusions 5. Formal thought disorder

Answer 124

Affective flattening Schizophrenia is characterised by positive symptoms including delusions, hallucinations, formal thought disorder, bizarre behaviour and inappropriate affect. The negative symptoms include poverty of speech (alogia), affective flattening/blunting, avolition, apathy, anhedonia, asociality and attentional impairment. The negative symptoms become more prominent as the illness becomes chronic.

Question 125

Mr.Y is a 21-year-old gentleman who was admitted to a psychiatric inpatient unit 4 months ago. His clinical presentation includes inappropriate affect, senseless giggling, mirror-gazing for long periods of time, poor self-care and hygiene, marked thought disorder and severe loosening of association. He also exhibits fragmentary and changeable delusions and hallucinations. Which of the following is the most likely diagnosis? Select one: 1. Post schizophrenic depression 2. Catatonic schizophrenia 3. Paranoid schizophrenia 4. Residual schizophrenia 5. Hebephrenic schizophrenia

Answer 125

Hebephrenic schizophrenia Hebephrenic schizophrenia is characterised by marked thought disorder and severe loosening of associations, Emotional disturbances characterised by inappropriate affect, blunted affect or senseless giggling, abnormal mannerisms like mirror gazing. There is markedly impaired social and occupational functioning; poor self care, poor hygiene, extreme social behaviour and disorganised behaviour. ICD10 recommends a period of 2-3 months of continuous observation for making a confident diagnosis.

Question 126

A 21-year-old woman often falls asleep during the day. She has fallen asleep while speaking to her manager twice, causing problems at work. Her night time sleep is undisturbed, and other spheres of functioning are satisfactory. Physical health is unremarkable except for a history of an episode of fall 2 weeks ago when she was on a train laughing heartily with her boyfriend. She did not sustain any head injury then. Which of the following is the most appropriate diagnosis for this case? Select one: 1. narcolepsy 2. hypersomnia not otherwise specified 3. primary hypersomnia 4. circadian rhythm sleep disorder 5. no illness

Answer 126

Narcolepsy Narcolepsy is characterised by the presence of both cataplexy and daytime sleepiness. Emotional stimuli such as laughter, startle, excitement, or anger can precipitate cataplexy. They tend to fall due loss of tone in anti-gravity muscles of the legs. However, most attacks are mild and last only a few seconds.

Question 127

A sportsperson is found to use excessive analgesics to help symptoms of pain following intense training. He abuses analgesics in doses that are much higher than the prescribed amount and refuses to stop them despite medical advice. In ICD10, this condition is described in which of the following chapters? Select one: 1 .Organic mental disorders 2. Neurotic, stress-related and somatoform disorders 3. Disorders of personality and behaviour 4. Mental and behavioural disorders due to use of psychoactive substances 5. Behavioural syndromes associated with physiological disturbances and physical factors

Answer 127

Behavioural syndromes associated with physiological disturbances and physical factors **NO LONGER THE CASE IN ICD-11 - CATEGORISED UNDER DISORDERS DUE TO SUBSTANCE ABUSE OR ADDCTIVE BEHAVIOURS -CAN LEAD TO DEPENDENCE AND WITHDRAWAL** Although it is usually clear that the patient has a strong motivation to take the substance, dependence or withdrawal symptoms do not develop when abusing analgesics, unlike what is seen in the case of psychoactive substances specified in F10-F19 ('Mental and behavioural disorders due to psychoactive substance use') of ICD-10. The abuse of analgesics is described under F50-F59 ('Behavioural syndromes associated with physiological disturbances and physical factors').

Question 128

What is the minimum symptom duration required to make an ICD-10 diagnosis of schizophrenia? Select one: 1. 6 months 2. 3 months 3. 1 month 4. 1 week 5. 1 day

Answer 128

1 month For an ICD 10 diagnosis symptom duration of at least 1 month is generally required while with DSM, duration of at least 6 months is needed. If the duration is less than one month then a diagnosis of acute schizophrenia-like psychotic disorder should be made.

Question 129

A 12 yr old boy is found to be skipping school repeatedly and using drugs with his friends. He is most likely to have which of the following diagnosable psychiatric conditions? Select one: 1. Asperger's syndrome 2. Oppositional defiant disorder 3. Autism 4. ADHD 5. Conduct disorder

Answer 129

Conduct disorder Conduct disorder is an enduring set of antisocial and aggressive behaviours that evolves over time, usually characterized by aggression and violation of the rights of others.

Question 130

Which one among the following symptoms is not classified under Schneiderian first rank symptoms of schizophrenia? Select one: 1. Thought insertion 2. Delusional perception 3. Waxy flexibility 4. Third person singular hallucinations 5. Thought broadcasting

Answer 130

Waxy flexibility Waxy flexibility is classified under Catatonia. Here parts of the patients' body can be placed in positions that will be maintained for long periods of time even if very uncomfortable and the patient is flexible like a wax.

Question 131

People with which of the following personality disorders find it hard to make decisions easily? Select one: 1. Schizotypal personality 2. Narcissistic personality 3. Schizoid Personality 4. Anxious avoidant personality 5. Anankastic Personality

Answer 131

Anankastic Personality People with OCPD (anankastic PD) find it hard to decide on even seemingly trivial issues, leading to frustration at times.

Question 132

A 33-year-old man has experienced low mood, fatigue and negative cognitions for the last 2 weeks. There is no personal or family history of mood disorders. He has been generally healthy apart from an episode of flu that occurred 2 weeks ago. Which of the following is an appropriate diagnosis? Select one: 1. Chronic fatigue syndrome 2. Bipolar disorder 3. Encephalitis 4. No mental illness 5. Depressive episode

Answer 132

Depressive episode Low mood, fatigue and negative cognitions for the last 2 weeks is suggestive of a depressive episode.

Question 133

A mother complains that her 20-year-old son is upsetting his employers by being very rigid in his duties and not able to delegate tasks. He also has difficulties in discarding his materials and hoards items including old newspapers in his office. What is the most likely diagnosis? Select one: 1. Schizoid personality 2. Obsessive compulsive disorder 3. Normal presentation 4. Anankastic personality disorder 5. Schizophrenia

Answer 133

Anankastic personality disorder People with OCPD (anankastic PD) find it hard to dispose of possessions and may hoard them. They also struggle to decide on even seemingly trivial issues, leading to frustration at times.

Question 134

Which of the following classificatory systems require 6 months duration with at least 2 out of 5 described symptoms to be present for a diagnosis of schizophrenia? Select one: 1. DSM-5 2. Research Diagnostic Criteria ICD10 3. ICD10 4. DSM-IV 5. St Louis Criteria

Answer 134

DSM-5 DSM-5 requires, for the diagnosis of schizophrenia at least two of the symptoms of delusions, hallucinations, disorganized speech, grossly disorganized catatonic behaviour or negative symptoms producing social-occupational dysfunction. In DSM-IV a diagnosis could be made with only one symptom in criterion A - bizarre delusions or Schneiderian hallucinations. Both DSM-IV and DSM-5 require a total duration of at least 6 months, including 1 month of active symptoms during this time.

Question 135

Which of the following clinical phenomenon is associated with the name Angst? Select one: 1. Folie a deux 2. Cycloid psychosis 3. Mixed affective states 4. Bipolarity of mood disorders 5. Unitary psychosis

Answer 135

Bipolarity of mood disorders Angst has been a strong proponent of bipolarity of mood disorders and the concept of bipolar spectrum disorders.

Question 136

A 23-year-old gentleman was started on an anti-psychotic medication 3 weeks ago. During a follow-up appointment he reports no improvement in his symptoms. What is the most sensible next step? Select one: 1. Add another antipsychotic medication 2. Augmentation with an anticonvulsant medication 3. Explore potential non-adherence 4. Increase the dose of the antipsychotic medication 5. Change to another antipsychotic drug

Answer 136

Explore potential non-adherence The commonest cause for lack of improvement in psychotic patients is non-compliance with antipsychotic medication and therefore it should be explored first. Even when adherence is not an issue, at least 2-4 weeks of treatment with anti psychotics may be needed to see an initial effect and obtain a full and optimal response to medication. The patient should be treated for a minimal period of 6 months. The reasons for non-compliance may include discomfort resulting from treatment (e.g.side effects), expense of treatment, decisions based on personal value and judgements, religious or cultural beliefs about the advantages and disadvantages of the proposed treatment, personality traits or adverse coping styles (e.g., denial of the illness) or the presence of a serious mental disorder (e.g schizophrenia).

Question 137

Mr X is a 31-year-old gentleman who has suffered three manic episodes and 1 episode of depression in the past. He is already on antipsychotics and antidepressants. When reviewed in the out-patient clinic, he complains of low mood, frequent crying spells, poor concentration and lack of enjoyment in things he used to do. Which one of the following is the most appropriate medication for his condition? Select one: 1. Amitriptyline 2. Lamotrigine 3. Venlafaxine 4. Sertraline 5. Mirtazapine

Answer 137

Lamotrigine This gentleman is suffering from bipolar depression which is a common and debilitating disorder which differs from unipolar disorder in severity, time, course, recurrence and response to drug treatment. Episodes of bipolar depression are more rapid in onset, more severe, but often shorter in nature compared to unipolar depression. Lamotrigine appears to be effective both as a treatment for bipolar depression and as a prophylaxis against further episodes. It does not induce switching or rapid cycling. Antidepressant monotherapy is not recommended due to the risk of precipitating a switch to mania.

Question 138

Asperger's syndrome is characterised by all of the following except Select one: 1. Lack of friendships 2. Restrictive, repetitive or stereotyped patterns of behaviour 3. Impaired reciprocal social interaction 4. Impaired intellectual ability and syntactical speech 5. Lack of awareness of the feeling of others

Answer 138

Impaired intellectual ability and syntactical speech Asperger's syndrome is characterised by severe persistent impairment in social interactions, repetitive behaviour patterns, and restricted interests. IQ and language are normal. Unlike autistic disorder, in Asperger's disorder no significant delays occur in language, cognitive development, or age-appropriate selfhelp skills. According to DSM-IV, clinical features include at least two of the following indications of qualitative social impairment: Markedly abnormal nonverbal communicative gestures, the failure to develop peer relationships, the lack of social or emotional reciprocity, and an impaired ability to express pleasure in other persons' happiness. Restricted interests and patterns of behaviour are always present, but when they are subtle, they may not be immediately identified or singled out as different from those of other children. Mild motor clumsiness and a family history of autism may be present.

Question 139

A 25-year-old man has experienced an irrational fear of darkness since childhood. He is not distressed by this currently and does not take special measures to avoid dark spaces. Which of the following is true? Select one: 1. He has a specific phobia as he has an irrational fear 2. He has no specific phobia as fear of darkness is common 3. He has a specific phobia with loss of insight 4. He has no specific phobia as he does not have an avoidance behaviour 5. He has a specific phobia as he has it since childhood

Answer 139

He has no specific phobia as he does not have an avoidance behaviour Specific phobias are restricted to highly specific situations such as proximity to certain animals, natural phenomenon such as heights, thunder, darkness, flying, being trapped in closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. The trigger is often discrete, but symptoms of anxiety are similar to panic attacks seen in other anxiety disorders

Question 140

A 42-year-old learning disabled man lives in a sheltered accommodation; he attends day centre twice a week and gets regular visitors. He cannot write or read but can speak using restricted phrases. He needs supervision for daily activities and cannot be trained easily; His social worker helps him with finances. What level of mental retardation does he have? Select one: 1. Below average 2. Moderate 3. Severe 4. Mild 5. Profound

Answer 140

Severe Speech minimal; Can talk or learn to communicate. Generally unable to profit from training in self-help. May contribute partially to self-maintenance under complete supervision later in life. Approximate IQ range of 20 to 34 (in adults, mental age from 3 to under 6 years). Likely to result in a continuous need of support.

Question 141

Which of the following is a poor prognostic factor for schizophrenia in terms of relapse/recovery from the illness? Select one: 1. Late onset 2. Higher premorbid functioning 3. Presence of affective symptoms 4. Male gender 5. Acute onset

Answer 141

Male gender Males have distinctly poorer prognosis than females with schizophrenia. This is thought to be linked to the early age of onset in males.

Question 142

A 40-year-old lady had an episode of depression 4 years ago. For last 4 weeks she is low in mood, socially isolating herself and fears going out of home; she fears experiencing a panic attack if she goes out. She is quite tearful and has not slept much for the last four weeks. The most appropriate working diagnosis is Select one: 1. Agoraphobia 2. Depressive relapse 3. Generalised anxiety 4. Dysthymia 5. Panic disorder

Answer 142

Depressive relapse Low mood, social isolation, tearfulness, lack of sleep along with a past history of depression is suggestive of a depressive relapse.

Question 143

According to DSM-IV criteria, the core symptoms of ADHD must have their onset Select one: 1. Before 12 years of age 2. Before 7 yrs of age 3. Before 9 years of age 4. Before 3 years of age 5. Before 18 years of age

Answer 143

Before 7 yrs of age Diagnostic criteria: According to DSM-IV criteria, to meet the diagnosis of ADHD, some symptoms must be present before the age of 7 years although ADHD is not diagnosed in many children until they are older than 7 years when their behaviours cause problems in school and other places. Note that DSM-V has introduced changes in the diagnosis of ADHD: symptoms can now occur before age 12 rather than before age 7; several symptoms now need to be present in more than one setting rather than just the impairment criteria being satisfied in more than one setting; new descriptions are now added to capture ADHD features in later ages; for individuals aged 17 or older, only 5 symptoms are required for a diagnosis instead of the usual 6 needed in children.

Question 144

A 32-year-old woman was brought by the Police to the A&E Department after she was found attempting to gain access to a hotel room where a popular football player was staying. She stated that the football player invited her into his hotel room and also claimed that they were secretly married. The football player denied this but admitted that the woman had sent him hundreds of emails over the last year. The woman had not been in trouble with the law so far and was functioning well in the community. Which of the following is the most likely diagnosis? Select one: 1. De-Clerambault syndrome 2. Othello syndrome 3. Fregoli syndrome 4. Ekbom syndrome 5. Capgras syndrome

Answer 144

De-Clerambault syndrome De-Clerambault syndrome is classified under persistent delusional disorders. It occurs most often in women, and there is an erotic conviction that a person with higher status is secretly in love with the patient. The patients make efforts to contact this person, and some cases are associated with dangerous or assaultive behaviour.

Question 145

Which of the following is correct concerning atypical anorexia nervosa? Select one: 1. All symptoms of anorexia are present but with milder severity 2. Menarche is never attained 3. Weight is normal 4. Depression is not present 5. Normal body image perception

Answer 145

Normal body image perception According to ICD, in atypical anorexia, most features of anorexia are present except that one of the key features such as amenorrhea or altered body image may not be seen. (Please note - DSM defines atypical anorexia differently; According to DSM this term is used for those who have all features of Anorexia but absolute current weight above or within normal range).